A private plan means an employer, group or individual plan, program or account, that could provide coverage for drug products, including facilitating the funding that could be used to pay for drug products, regardless of the following:
Children and youth age 24 and under who have a private plan will not be eligible for OHIP+ regardless of whether:
Children and youth age 24 and under who have a private plan will access drug coverage through their private plan, as they did prior to the launch of OHIP+.
Households with high out-of-pocket prescription drug expenses, including children and youth who are covered under a private plan, can apply to the Trillium Drug Program. The Trillium Drug Program is available to all OHIP-insured Ontarians who have high prescription drug costs in comparison to their household income. To find out more about the Trillium Drug Program and eligible prescription costs please visit: www.ontario.ca/trilliumdrugprogram or call the Trillium Drug Program toll free at 1-800-575-5386.
OHIP+ completely covers the cost of more than 4,400 drug products that are currently available through the Ontario Drug Benefit Program, including:
To find out if your medication is covered through the Ontario Drug Benefit Program visit www.ontario.ca/page/check-medication-coverage/ or ask your Guardian or I.D.A. pharmacist for more information.
Medications available through the Exceptional Access Program may also be covered if an individual qualifies
If the prescribed medication is not covered by OHIP+, your Guardian or I.D.A. pharmacist may be able to recommend alternative medications that are covered by OHIP+.
If you have private insurance, some drugs not covered by OHIP+ may be covered by your insurance plan.
The Exceptional Access Program (EAP) may enable access to some medications for which no appropriate alternative is covered by OHIP+. Your healthcare provider is required to submit a request on your behalf. If approved, the full cost of the medication will be covered. Visit www.ontario.ca/page/applying-exceptional-access-program for more information on EAP.